碘染色与窄带成像技术模式下内镜分级在早期食管癌疾病诊断中的应用价值

The Application Calue of Endoscopic Grading in the Diagnosis of early Esophageal cancer using Iodine Staining and Narrowband imaging Techniques

目的 探讨早期食管癌临床诊断中应用碘染色与窄带成像的效果。方法 将2019年1月至2019年12月于安阳市肿瘤医院、河南科技大学第四附属医院就诊的食管癌早期患者作为研究对象,共92例(124处病变部位)。对所有患者均进行常规内镜、内镜窄带成像技术(NBI)模式内镜检测分级及碘染色下内镜分级,金标准为病理诊断结果,分析病理检测结果和三种检测方法的检测结果的差异,统计并比较诊断价值(符合率、诊断敏感度、特异度等)。结果 病理诊断结果可见,92例早期食管癌患者(124处病变部位)阳性病变112处,阴性12处;其中常规内镜检测阳性68处,阴性56处;碘染色阳性99处,阴性25处;NBI阳性97处,阴性27处;诊断符合率分别为66.13%、86.29%、83.06%,其中碘染色、NBI的诊断符合率均高于常规内镜检测,差异有统计学意义(P<0.05)。三种检测方法的诊断敏感度、特异度及阴性预测值差异显著,其中碘染色、NBI的诊断敏感度(86.61%、83.93%)、特异度(83.33、75.00%)及阴性预测值(40.00%、33.33%)均高于常规内镜检测,差异有统计学意义(70.54%、25.00%、8.33%,P<0.05)。NBI和碘染色分级Ⅰ级病变多为高级别内瘤变,而Ⅱ、Ⅲ级病变多为低级别内瘤变。结论 碘染色、NBI内镜应用于诊断早期食管癌的诊断价值较高,有助于及早发现病情,为临床尽早作出判断和治疗提供依据,但是NBI内镜简洁方便,耗时少,且可清晰显示早期食管癌病变的毛细血管结构形态,有助于确定食管癌浸润深度,协助选择合适的治疗方案。

Objective To investigate the effect of applying iodine staining and narrow band imaging in the clinical diagnosis of early esophageal cancer.Methods A total of 92 patients with early-stage esophageal cancer(124 lesion sites) who were treated at Anyang Cancer Hospital and the Fourth Affiliated Hospital of Henan University of Science and Technology from January to December 2019 were selected.All patients were graded by conventional endoscopy,endoscopic narrow-band imaging(NBI)mode endoscopic detection and endoscopic grading under iodine staining,and the gold standard was pathological diagnostic results.The differences between the pathological detection results and the detection results of the three detection methods were analyzed,and the diagnostic values(compliance rate,diagnostic sensitivity,specificity,etc.) were counted and compared.Results The pathological diagnostic results showed that 92 patients with early oesophageal cancer(124 lesion sites) had 112positive lesions and 12 negative lesions;among them,68 were positive and 56 were negative by conventional endoscopy;99 were positive and 25 were negative by iodine staining;97 were positive and 27 were negative by NBI;the diagnostic compliance rates were 66.13%,86.29% and The diagnostic compliance rates were 66.13%,86.29% and 83.06% respectively,with the diagnostic compliance rates of iodine staining and NBI being higher than those of conventional endoscopy(P<0.05);the diagnostic sensitivity,specificity and negative predictive values of the three tests were significantly different,with the diagnostic sensitivity(86.61%,83.93%),specificity(83.33,75.00%) and negative predictive values(40.00%,33.33%) of iodine staining and NBI being higher than those of conventional endoscopy,33.33%) were higher than those of conventional endoscopic testing(70.54%,25.00%,8.33%,P<0.05);NBI and iodine staining graded grade Ⅰ lesions were mostly high-grade endomatous lesions,while grade Ⅱ and Ⅲ lesions were mostly low-grade endomatous lesions.Conclusion Iodine staining,NBI endoscopy used in the diagnosis of early esophageal cancer diagnosis value is higher,help to early detection,provide the basis for clinical judgment and treatment as soon as possible,but NBI endoscopy concise and convenient and less time consuming,and can clearly show early esophageal cancer lesions capillary structure morphology,help to determine the depth of esophageal cancer infiltration,help to choose the appropriate treatment.